AccountId: 011433970860
ContactId: bcdc4ff8-08db-44f4-8250-d4f418c35448
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327160 ms
Total Talk Time (AGENT): 121986 ms
Total Talk Time (CUSTOMER): 162168 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/bcdc4ff8-08db-44f4-8250-d4f418c35448_20250306T23:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi this is [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] I had a letter come to me that stated um.
[CUSTOMER][NEGATIVE] Parkview it says noncovered service and then the backside stated office visits are not covered so I contacted my insurance they're gonna send me the.
[CUSTOMER][NEUTRAL] Uh, itemized billing or.
[CUSTOMER][NEUTRAL] Whatever it is.
[CUSTOMER][NEUTRAL] Explanation of benefits sorry.
[CUSTOMER][NEUTRAL] They're gonna send that to me so that I can get it to you folks because right now it states that the total bills charged was 43148.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you received an explanation of benefits from our company?
[CUSTOMER][NEUTRAL] Well, no, the letter said.
[CUSTOMER][NEUTRAL] Uh, it has from to patient provider of service service description.
[CUSTOMER][NEUTRAL] Uh, 0 paid and then when you flip it over.
[CUSTOMER][NEUTRAL] That's when it says.
[CUSTOMER][NEUTRAL] Um, explanation of benefits, it says remarks. Office visits are not covered by the above numbered policy. Benefits are payable only if your major medical insurance provider provides benefits.
[CUSTOMER][NEUTRAL] If this claim is later paid by your major medical insurance, please send the explanation of benefits, that's what it says.
[AGENT][NEUTRAL] OK, on that EB what's the policy number?
[CUSTOMER][NEUTRAL] Um, the policy number is 01947256.
[AGENT][NEUTRAL] OK, thank you. And that claim number?
[CUSTOMER][NEUTRAL] Uh, the claim number is 356-720-2.
[AGENT][NEUTRAL] OK, thank you. Give me one moment to pull up this policy.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] Yes, ma'am, and Ms. [PII], verify your date of birth, mailing address and the email address for me, please.
[CUSTOMER][NEUTRAL] [PII]. I'm at [PII], and I think you said email. I think my work might be there was [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII] is my work cell.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh let me see, look at this claim, give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, yes, ma'am. Under your policy with our company, it doesn't cover office visits, but there was another charge to where uh we're needing that primary EOB if they applied any amounts towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, because we just switched over insurance companies I believe.
[CUSTOMER][NEUTRAL] I guess.
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Uh, yes, ma'am. I'm just looking to claim. You may contact your group administrator and they can verify who your major medical insurance is with, but with this policy you have with us is a secondary supplemental policy only.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I know that, but um.
[CUSTOMER][NEGATIVE] So I have to call my my current insurance or do you guys bill them first? I don't understand how this works.
[AGENT][NEUTRAL] Well, we don't bill anybody. Uh, what happens is when you give the provider, which it looks like it's um Parkview, your primary insurance, and you give them our information is secondary, what they would do is submit the claim to your primary. Your primary processes the claim and then they will send the claim to us as secondary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it looks to me like since the insurance has changed they probably didn't take care of it first.
[AGENT][NEUTRAL] Cause it looks like on here, is it your major medical with United Healthcare?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, that's who, um, we're showing based on the ELB we received as your primary, um.
[CUSTOMER][NEUTRAL] Does it show I owe this much?
[AGENT][NEUTRAL] Um, that we can't give because we only pick up deductible, co-pay or co-insurance, but I don't see anything on here as far as patient responsibility. Um, you probably verify with your major medical.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll just wait till they send me those um.
[CUSTOMER][NEUTRAL] Explanation of benefits and see if I need to do anything further.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Already?
[AGENT][NEUTRAL] All right, Ms. [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] What thing?
[CUSTOMER][NEUTRAL] No, nothing at the moment. I'm just making sure I don't have a bill lingering somewhere that I need to pay it, that's all.
[AGENT][NEUTRAL] Oh, I understand. Yes, ma'am.
[CUSTOMER][POSITIVE] Yeah, yeah, I don't like to let those bills sit there somewhere. Thank you so much I appreciate your help.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Uh, you are welcome and thank you for calling APL. You have a great day.
[CUSTOMER][POSITIVE] Yes you too bye bye.
[AGENT][NEUTRAL] Bye.